Surgery today
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Secondary aortoenteric fistulas (AEFs) are a well-known but uncommon cause of gastrointestinal hemorrhage. They usually occur secondary to reconstructive surgery of an abdominal aneurysm. We report six cases of secondary aortoduodenal fistulas, involving patients who, despite presenting with classic "herald bleeding," died as a result of delayed operative intervention. We also discuss the pathogenesis, clinical presentation, and diagnosis of AEFs, emphasizing the value of clinical suspicion and negative endoscopy in establishing the diagnosis and the need for early operative intervention.
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Adult intussusception represents only about 5% of all intussusceptions and is usually caused by a malignant small bowel lesion acting as the apex of intussusception. We report an unusual case in a male patient of adult intussusception caused by a lipomatous lesion located in the terminal ileum, very close to the ileocecal valve, acting as the lead point. ⋯ The patient underwent a limited right hemicolectomy, which achieved long-lasting cure of his symptoms. This case highlights the difficulties of diagnosing adult intussusception promptly, and the fact that it can also be caused by a benign lesion.
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Comparative Study
Preoperative iron supplementation and intraoperative transfusion during colorectal cancer surgery.
To investigative whether giving an iron preparation to anemic patients before colorectal cancer surgery improves their anemia and reduces the need for intraoperative blood transfusion. ⋯ Iron supplementation for at least 2 weeks before colorectal cancer surgery increases Hb and Ht values in anemic patients, and reduces the need for intraoperative transfusion.
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Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. It is usually managed by drainage and pleurodesis, but there is no consensus as to the best method of pleurodesis. We compared the effectiveness, side effects, and cost of different chemical pleurodesis agents used in patients with malignant pleural effusion. ⋯ Talc resulted in the earliest expansion, minimal drainage, and the earliest tube and catheter removal.
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Elevated intra-abdominal pressure causing widespread organ dysfunction is known as abdominal compartment syndrome (ACS). The subject of our case report is a 64-year-old man who underwent repair of a ruptured descending thoracic aortic aneurysm (TAA) under deep hypothermic circulatory arrest. ⋯ We report this case to alert surgeons to the fact that ACS can occur during surgery on the thoracic aorta, especially if massive fluid resuscitation is required and venous drainage for extracorporeal circulation is less than optimal. Early recognition and prompt decompression by laparotomy is essential to save the life of the patient.